Prospective, Randomized Trial of Two Different Modalities of Flushing Central Venous Catheters in Pediatric Patients With Cancer

Abstract

An increased complication rate was found with normal saline flushing, but additional investigation is warranted to clarify whether it is related to saline use or to once-a-week flushing.

Heparin versus 0.9% sodium chloride intermittent flushing for the prevention of occlusion in long term central venous catheters in infants and children: A systematic review

“…We contacted three individual study authors for further study details and were able to find further information for two studies (Goossens et al, 2013, Smith et al, 1991. Of the 10 studies, three met the inclusion criteria (Cesaro et al, 2009, Goossens et al, 2013, Smith et al, 1991 and were included in this review. Details of data extraction are summarised in Table 1.…”

“…A flow chart detailing the identification of studies can be found in Figure 1. The studies undertaken by Cesaro et al, (2009) and Goossens et al, (2013) were of medium duration (25 and 23 months respectively) and included follow-up periods of 14 and six months respectively. The Smith et al, (1991) study was a cross-over study of two, three-and-a-half month time periods (total duration seven months) and did not include a follow-up period.…”

“…The three included trials involved a total of 245 participants, with the majority of participants (203) coming from Cesaro et al, (2009). From the other two studies, Goossens et al, (2013) contributed 28 participants, and Smith et al, (1991) contributed 14.…”

Thrombolytic therapy for central venous catheter occlusion

“…52 However, a prospective study that evaluated twice weekly heparin flushes versus weekly saline flushes in 203 children with Broviac-Hickman CVCs demonstrated an increased rate of catheter occlusions (83% vs. 41%, P=0.0002) and catheter infections (65% vs. 44%, P=0.01) with saline flushes. 53 Although most guidelines for subcutaneous ports recommend monthly flushes when not in use, two studies have demonstrated that increased periods of time between flushes, from six weeks to three months, may not increase the frequency of complications. 54,55 Additional prospective trials are required to accurately determine the frequency and type of solution required to optimize CVC function and minimize complications.…”

The Care of Central Venous Catheters in the Oncopediatric Department

“…The dose of heparin varies in function of catheter type and period of closing. 16 Guidelines for the prevention of complications associated with CVC vary greatly. The widest recommendation is for the use of heparin to prevent occlusion, but some articles suggest that 0.9% sodium chloride (normal saline) may be as effective.…”